Dentoalveolar Surgery

Dentoalveolar surgery refers to all surgical procedures involved with the teeth and associated structures i.e. bone and soft tissues. Dr. S.M. Balaji has extensive surgical experience and performs the surgical procedure(s) quickly and with less surgical trauma.

Commonly, dentoalveolar surgeries include:

1. Tooth extractions or exodontia: Teeth may need to be removed for many reasons including severe decay, advanced gum disease, infection or as part of an orthodontic treatment plan.

Exodontia or tooth extraction

X-ray taken before extraction of upper right third molar tooth

During extraction- Accessing the tooth from the cheek side

During extraction- accessing the tooth from the tongue side

During extraction- Grasping the tooth with forceps

The extracted upper right third molar

2. Transalveolar extraction of impacted teeth: Sometimes a tooth may fail to emerge into proper alignment and remains “entrapped” in the gum tissue and jaw bone. Such tooth is referred to as impacted. Impactions may occur due to various reasons. For example, the jaw may be too small and there may be insufficient space for the teeth to erupt. Teeth may also become twisted, tilted, or displaced as they try to emerge, resulting in impacted teeth.

The most common impacted teeth are wisdom teeth or third molars. Impacted teeth may result in swelling, pain and infection of surrounding gum tissue. Also, impacted teeth may cause permanent damage to nearby teeth or lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, it is often recommend that impacted teeth be promptly removed.

X-ray showing two impacted lower canine teeth

Surgical exposure of impacted teeth

Immediately after surgical removal of impacted lower canine teeth

Severely decayed and impacted lower right wisdom tooth

Impacted wisdom tooth surgically removed atraumatically

-ray showing 6 impacted teeth- upper right and left third molars and lower right and left third and second molars

Surgical exposure of lower right impacted teeth

Surgical exposure of lower left impacted teeth

All impacted teeth removed

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X-ray showing teeth impacted in the lower right jaw region

Impacted teeth surgically removed

X-ray showing impacted upper right and left third molar teeth

Left tooth surgically exposed

Left tooth surgically exposed

Right tooth surgically exposed

Right tooth surgically exposed

Impacted teeth surgically removed

CT scan image showing impacted upper right canine in the right maxillary sinus

CT scan image showing impacted upper right canine in the right maxillary sinus

3. Surgical Endodontic procedures: The most common of these is a surgical apicoectomy, which is usually performed on a root canal treated tooth that has become infected or painful. An apicoectomy is a procedure in which the gum tissue near the tooth is opened to see the underlying bone and infected tissue is removed. The very end of the root tip is also removed and the root canal filling is sealed.

During apicoectomy- infection at root tip exposed

Apicoectomy done

Apicoectomy done

Immediately after apicoectomy

Diagramatic illustration of infection in root apex

Diagrammatic illustration of apicoectomy procedure

4.trong>Pre-Prosthetic surgeryan>: Sometimes surgical modifications of the jaw bone and soft tissues are required to enable the placement of a well-fitting, comfortable and aesthetic dental prosthesis such as dentures or dental implants. This preparation is referred to as pre-prosthetic surgery.

It is important that the bony ridge and soft tissues be of proper size and shape before placing the prosthesis. To achieve this, one or more of the following procedures might be needed.

Bone smoothing and reshaping (alveoloplasty)- irregular or sharp bone ridges are smoothened off

Bone grafting – this is required to “fill in” the bony defects. When there is missing teeth, jaw bone tends to shrink over time. There may not be sufficient bone to place dental implants or prosthesis. Or bone defects may occur due to gum disease. Bone grafting is a procedure to rebuild bone in the bone deficient areas of the jaw. For this, bone may be harvested from other parts of the jaw, patient’s rib or bone substitutes may be used.

Removal of excess bone (exostoses)- large and irregular chunks of excess bone may need to be removed to allow denture to fit properly

Adding, removing or reshaping the soft tissues- the soft tissues inside the mouth may require to be surgically corrected to have a well-fitting, stable denture. Excess soft tissue may require to be removed or some tissues may need to be repositioned to ensure a successful prosthesis. Soft tissue grafting may sometimes be required.

Upper jaw adequately advanced and brought into more favourable position in relation to lower jaw

After completeion of prosthetic rehabilitation with ceramic crowns and correct teeth alignment

5. Exposure and bonding of unerupted teeth for orthodontic purposes – some teeth do not erupt normally and remain buried in the jaw bone. Unlike impacted wisdom teeth which are often removed, these teeth (e.g. cuspid teeth in upper jaw) are important for good dental form and function. Such “hidden” teeth may need to be surgically “uncovered” by a procedure called operculectomy and an orthodontic appliance needs to be fixed to them that will gradually bring the tooth into normal position.

6. Biopsy and removal of simple cysts and other lesions of the mouth – Some lesions occurring in the mouth and maxillofacial region required to be examined for any disease. A tissue sample is taken from the lesion and sent for histopathological examination. This procedure is called a biopsy. Some simple lesions and infections including cysts have to be removed.